BEACON MEDICAL GROUP INC. NPI 1639196249

NPI Information

NPI: 1639196249
Provider Name: BEACON MEDICAL GROUP, INC.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
:
CLIA Number: 15D0714505
Address: 3301 COUNTY ROAD 6 E
ELKHART, IN
ZIP 46514
Phone: (574) 264-9635

Map and Directions

Get Directions

NPI Details

BEACON MEDICAL GROUP, INC. is a family medicine in Elkhart, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BEACON MEDICAL GROUP, INC. NPI is 1639196249. The provider is registered as an organization entity type and is a multi-specialty group.
The provider .

The provider's business location address is:

3301 COUNTY ROAD 6 E
ELKHART, IN
ZIP 46514-673
Phone: (574) 264-9635
Fax: (574) 262-0398

The provider's authorized official is Jeffrey P Costello .
The authorized official title is Cfo and has the following contact phone number (574) 647-3549.

The CLIA number assigned to this NPI record is 15D0714505 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/17/2006 and was last updated on 2/5/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		Yes
2	207R00000X	Internal Medicine		No
3	207RN0300X	Internal Medicine	Nephrology	No
4	207X00000X	Orthopaedic Surgery		No
5	213ES0103X	Podiatrist	Foot & Ankle Surgery	No
6	363LF0000X	Nurse Practitioner	Family	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100114000A	MEDICAID	INDIANA
2	ANTHEM BCBS	OTHER	INDIANA	000000110759

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI

Next NPI